For those who have never experienced it before, it’s enough to make you think that a fiery death is imminent. That painful burning in your chest, just behind your sternum, is heartburn, and although the occasional bout of it isn’t going to drive you to an early grave, it might remind you to lay off the Mexican food so close to bedtime.
Heartburn is caused when acid from the stomach splashes back into the esophagus because of a malfunctioning valve called the esophageal sphincter. For some people, heartburn is a major symptom of gastroesophageal reflux disease, a chronic disorder. Many people, however, have only occasional episodes of heartburn. To combat it, conventional wisdom dictates that you should cut out spicy foods, avoid eating close to bedtime, watch your intake of citrus and alcohol, and prop up the head of your bed so that gravity keeps the acid down. These are all good tips, assuming one of the conventional triggers is causing your heartburn. But like many conditions, not all heartburn stems from common causes.
Taking certain drugs puts some people at risk of heartburn, even if their dietary habits and lifestyle wouldn’t otherwise cause it. Medications to treat heart disease and high blood pressure can relax the muscles in the chest—including the esophageal sphincter—and cause it to become lazy, at which point it allows acid to splash out of the stomach. Oral asthma medications have a similarly relaxing effect. Drugs that fight osteoporosis are well known for causing acid reflux, so much so that they usually come with a warning that women taking them should not lie down immediately afterward. These drugs can increase acid production, as well as damage the lining of the esophagus. It’s also important to limit citrus intake when taking these medications, since citrus is a known trigger of heartburn.
Even nonprescription NSAID pain relievers have been associated with heartburn. People who regularly take these pills for arthritis, headaches, heart disease, or chronic pain are more susceptible to heartburn, as well as to other gastrointestinal problems. Taking the occasional aspirin or ibuprofen doesn’t usually raise a person’s risk, but it can happen. Other drugs that have been linked to heartburn include those used to treat cancer, Parkinson’s disease, muscle spasms, and anxiety.
There’s no doubt that exercising is good for you, but in matters of gastrointestinal function, it can actually cause problems. Exercising can cause or aggravate heartburn, and the more intense the activity, the worse the symptoms can be. Physicians don’t know exactly what makes exercise cause heartburn, but they hypothesize that straining during weight lifting or strenuous cardiovascular exertion can increase pressure in the abdomen and cause acid to splash back up into the esophagus.
Certain forms of exercise may be more problematic than others. Some people may be more bothered by running or aerobics, and others may experience heartburn only after lifting weights. The only way to alleviate the symptoms is to narrow down what the triggers are and eliminate them. Drinking plenty of water or diluted sports drinks can also help to keep stomach acid in check, as can avoiding high-fat foods in anticipation of a workout. Most experts recommend eating smaller meals and smaller portions, as well as letting food digest, before you begin to exercise, since working out on a full stomach is more likely to cause problems.
Some experts recommend specific exercises that can actually help digestion by improving transit times and minimizing constipation, heartburn, and other stomach woes. Yoga, Pilates, and other low-impact exercises are all good ways to keep the digestive tract moving smoothly.
Just Quit It
As if people needed more reasons to quit smoking, the habit also contributes to heartburn. Reports have shown that smoking not only causes the esophageal sphincter to malfunction, allowing acid into the esophagus, but also affects the salivary glands, preventing them from producing saliva to “clear” the esophagus of acid. When acid stays in the esophagus longer, it’s more likely to cause permanent damage. According to the National Heart Burn Alliance, smokers’ saliva also contains fewer bicarbonates to neutralize stomach acid, leaving smokers with more acidic stomach contents than nonsmokers.
These heartburn triggers may be surprising, but you can easily prevent them if you make lifestyle changes. Some chronic conditions and diseases can, unfortunately, also be marked by heartburn, so if you’re suffering from ongoing digestive problems that don’t have a readily identifiable cause, always consult a doctor. The cause is likely to be minor, but it’s important to mitigate recurrences of heartburn in order to protect the delicate tissues of the esophagus and throat—repeated exposure to acid can cause them to wear and ulcerate.
If it can’t be prevented, heartburn is usually managed with simple antacids (like Tums), acid-blocking medications (like Tagamet or Zantac), or proton pump inhibitors (like Nexium and Prilosec), which slow acid production and heal esophageal tissue. It’s normal for all kinds of people—young and old, thin and overweight—to be laid up with the occasional bout of heartburn, but figuring out what causes it can help prevent it from coming back.